Etiology of Osteomyelitis Complicating Sickle Cell Disease

The most common cause of osteomyelitis is Staphylococcus aureus .1,2 However, it is well-known that in children with sickle cell disease (SCD) who develop osteomyelitis, infection is often attributable to Salmonella . A controversy that arises is whether S aureus is the most common cause of infection in these children overall, or does Salmonella actually predominate. The authors of the chapter on osteomyelitis and septic arthritis in the current edition of a major pediatric text state that “ Salmonella osteomyelitis tends to occur more often in children with hemoglobinopathies, although even in this group, S aureus remains the predominant pathogen.”1 The authors of the chapter on osteomyelitis and septic arthritis in the current edition of a major pediatric infectious diseases text state that “seventy percent of all lesions or blood cultures in children with hemoglobinopathies and presumed osteomyelitis yield Salmonella microorganisms, 10% contain S aureus , and aerobic Gram-negative rods are isolated in 7%.”2 To support this statement, a single 1981 reference is cited that summarizes the results of nine reports previous to this time.3 No … Address correspondence to: James W. Bass, MD, MPH, Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI 96859-5000.